Shouting into the void a little here, but this my script for how I explain ADHD to patients/parents. Before you yell at me for over simplifying it, please hold your critique because I totally am. Most people aren't psychologists and if you're dealing with a kiddo who has ADHD chances are at least one parent has it.
1. ADHD stands for attention-deficit/hyperactivity disorder and it's
probably the single most misunderstood childhood condition by the media, general population, and those who have it because no one ever takes the time to discuss it! This disorder has had numerous different labels through the years including hyperactive child syndrome, hyperkinetic reaction of childhood, minimal brain dysfunction, and attention deficit disorder. Hyperactive kids have been discussed in the medical literature for at least 300 years - it's not a condition of modernity (although we can discuss how modern circumstances might make more obvious and why it exists). Why minimal brain damage? Because kids with ADHD act a lot like people after they have had a mild head insult, but without the obvious traumatic event that lead to a change is functioning. At this point I go to explain what the frontal lobe does, and might even talk about Phineas Gage to help them understand how it affects all sorts of things. Later we will discuss what's actually going on the frontal lobe with kids who have ADHD.
2.
The "attention deficit" part of ADHD is largely a misnomer. ADHD is a neurodevelopmental disorder - that means you're born with it, and it generally doesn't go away. In fact, those with ADHD are at risk for some pretty horrible outcomes if it is not treated. For example, people with ADHD are like 2x as likely to by age forty and like no one really dies by age forty. Why? - mostly car accidents, risk taking, and other poor decisions.
2a.
Attention is not really the problem in ADHD. If you think of attn as the light a flashlight that shines conscious awareness on things, those with ADHD have just as a good of flashlight as you and me. ADHD is a that impacts how good you shine that flashlight, do you keep it where it needs to be or do you jump around with it all willy nilly?
2b. The thing that controls where we point our flashlight is the frontal lobe. One way we talk about what it does are with the term "executive functions" and frontal lobe is where they live. Do you remember those old cartoons where Bugs Bunny is contemplating doing something naughty and a devil bugs and angel bugs pop up on his shoulder? Forget the devil part, but the executive functions act a lot like the angel or "mom" on your shoulder who helps you plan, think ahead, regulate emotions, get you back to work, and run behavioral simulations in your mind. They say hey (although this is an instantaneous nonverbal computer program always running in the back that say "hey get back to work" or "dude, remember how you want to do good in your class you can get that praise from the teacher" or even "dude, I know getting yelled at or told what to do sucks, but it just easier in the long run if you listen to your parents" or even "how does this look to others." Executive functions also help to regulate emotions (an overlooked part of ADHD). I might even pull up this:
Figure 2.1 Diagram of Barkley Model of behavioral inhibition, executive... at this point if the parent is capable and run through it.
3. A
t this point the parents are starting to wonder what we can do about ADHD. At this point, I draw a graph that with ADHD symptoms on the left side and I 1, 2, 3, 4 (sometimes), on the bottom. This graph outlines the MTA study. I say " The first study that really clarified how to treat ADHD was done with 600 kids who all had ADHD was the MTA study. At the beginning of the study they took the kids and put them for groups-each a different treatment condition." All 4 groups of kids had high levels of ADHD because of her kids with ADHD. The first group they gave him high-quality behavioral therapy. That resulted in some symptom reduction. The second group they gave him Ritalin. Later studies show that up to 75% of kids with ADHD normalized when given a stimulant. The third group received behavioral therapy and medication. They also had a ton of symptom reduction, but mathematically you could not tell them apart on main measures of attention and hyperactivity. The fourth group was community treatment as usual, and they have like no change in symptoms." The study has been replicated a lot.
4
. I then go on to talk about how dopamine is implicated in ADHD. I draw pictures to neurons and I say something like for if this neuron wants to send a message to this one, it needs to pass them a note - just like in class. Instead of a pen a paper, braincells uses chemicals. The neurotransmitter most implicated in ADHD is called dopamine. Put simply, people with ADHD have less dopamine than they need. This kind of means that there brain is "underactive." Wild, huh, because behaviorally they are so busy -counterintuitive, right? Dopamine does a lot of different things in the brain. 1 thing it does is makes boring tasks more tolerable. People without any ADHD are able to focus because they have a normal amount of dopamine and focusing on going things is more "pleasurable" to them. Or, it also helps them think ahead, because it makes the frontal lobe more active. Sometimes, a draw an "EKG." This is why your ADHD kids can focus on video games but not math - videogames with their social aspect, colors, interesting storylines, intermittent reinforcement help make a ton of dopamine.
4a. This is why meds are so important. Meds and ADHD are a lot like giving someone with diabetes insulin or someone with astigmatism glasses–they do not cure those condition, but they sure do make outcomes better. I'll even talk about their history, safety, and outcomes...
5. ADHD is tricky. One reason it is tricky is because kids with ADHD are just as intelligent as you or me. However, the way executive functions work,means they have trouble doing what they know. This is why nagging or giving tons of explanations does not seem to change their behavior. ADHD is not a disorder of "knowing what to do" rather, is a disorder of "doing what they know." The rubber just does not meet the road, even though their engine is pretty good.
6. What causes ADHD. ADHD is highly genetic. If you have an identical twin with ADHD, your chance of having it is like >80%. It runs in families. ADHD is not a modern condition. Although no single gene causes ADHD, some of the genetic analyses show that it is inherited and in evolutionary probands. One thing that kids with ADHD are really good is not thinking about the risks. An idea that some people floated is that people with ADHD helped the group to eat more back in caveman times, because they would not think twice about jumping on a flailing mammoth and bashing his head and with a rock, even though that is a very dangerous task. We know that it is a real condition because people with ADHD have very poor outcomes compared to those without it. I will outline some of those if I want to.
ADHD was not caused by anything you did. You are not a lazy or bad parent.
7. I talked about medication and the need to find the most effective one. At first, it is a little bit of a guessing game. Most people respond well to Ritalin or Adderall. But, "isn't that just meth." Sort of, there is a brand name for methamphetamine that you can get cleared for narcolepsy and ADHD. It is called Desoxyn.
The generic name for Adderall is mixed amphetamine salts. Amphetamines have been given to kids with ADHD since the 1930s. Taken orally, at therapeutic doses, they are really not scary. Amphetamine is a way better stimulant, in terms of safety, than even something like caffeine. Kids who take stimulants are less likely to abuse drugs in high school, because it turns up their executive functions. Sometimes, they work a little too well and get affective blunting. That means he may need a different class of stimulant or reduction in dose. There are literally 100s of different kinds of medication, even nonstimulants, that can really help ADHD. But there is a reason, that stimulants are the first-line treatment. The safety of stimulants in children has likely been study more than Tylenol people give Tylenol all the time. But there are some risks, as they are with any med
s. The most important things that finding the right med is a conversation to have with your prescriber and I am here to help you communicate your concerns and needs to the prescriber if you need me.
8.
Do not waste time on changing diets–that usually leads to a lot of conflict and does not really change behavior. Talk therapy for ADHD is usually a waste of time - unless the kid has anxiety or depression (30% of those with adhd do). What can really help are parent driven interventions targeting impulsivity, oppositionality, and compliance. But a lot of times when the meds start hitting, parents no longer feel the need to that, either.
Again, highly simplistic/reduced. I probably left some stuff out. But, I see a tons of "aha" moments with this type of discussion. Sometimes I'll talk a little bit more about why those with ADHD have big emotional reactions and are responding with normal emotions for the situation.
